Lung Cancer Chest X Ray Pharmacy referral pilot launched in Hywel Dda

WITHIN Wales, over 2,300 people are diagnosed with lung cancer each year. Of these, only 20% are diagnosed when the lung cancer is at an early stage when they are able to have surgery. This is partly because Wales has the lowest awareness of symptoms compared to the rest of the UK and Europe. Symptoms include an on-going cough, feeling tired, shortness of breath, chest pain, unexplained weight loss, and coughing up blood.

It is important to diagnose lung cancer early as this allows for a better response to treatment.   Although campaigns and advertising on TV have increased the awareness of lung cancer symptoms, these ads often do not reach everyone in the community.

So, from May residents in the Hywel Dda region who are experiencing symptoms that could be due to lung cancer will be able to access a new service.  In this new, innovative chest x-ray referral service, participating Community Pharmacies in the Llanelli and Burry Port area can discuss symptoms with patients and if suitable, they can refer people to Prince Philip Hospital for a chest x-ray.

The PLUS (Pharmacy Referral for Lung Cancer Symptoms) study, funded by Health and Care Research Wales is a collaboration between Hywel Dda University Health Board, Cardiff University, and Swansea University. They are working together to look at new ways to help people get diagnosed with lung cancer earlier.   It is the first time that community pharmacists in Wales can refer people to hospital for an x-ray if they have lung cancer symptoms. This study will involve 16 pharmacies as well as consultant physicians at Prince Philip Hospital, Llanelli.

Dr Gareth Collier MBE, respiratory consultant at Prince Philip Hospital and lead researcher on the study, said that he wants to “increase the number of patients we diagnose with lung cancer at an early stage, because finding lung cancer earlier can save lives.

“Studies have suggested late-stage presentation of lung cancer is associated with a low awareness of symptoms, as well as difficulty in accessing primary care and tests to diagnose cancer” he said.

“GPs are often concerned that awareness campaigns will overload their already stretched services. The PLUS study combines a public awareness campaign, developed with members of the local population, and can help people to more easily access healthcare advice and tests by using our very knowledgeable and accessible community pharmacy resource,” he said, adding that he hopes “this combination will result in a greater proportion of patients diagnosed at an early stage, while at the same time not overloading general practice.”

Part of this study will look to see if allowing pharmacies to refer people to hospital can reduce the time it takes to get a diagnosis of lung cancer. Pharmacies have previously helped with diagnosing diabetes and with helping people to stop smoking, and the expectation is that pharmacists will encourage patients who are experiencing symptoms to seek medical attention sooner.

It is anticipated that the research results will provide an understanding of which services can be developed to help patients get the most appropriate treatment for symptoms and will add to an area of research that is improving earlier diagnosis. This would mean patients would not need to see their GP first, and that diagnoses could be made earlier. This research will also help raise awareness of lung cancer symptoms for the whole community too.

There are some eligibility criteria for this study. Patients need to be:

Aged 40 or over

A current or ex-smoker (and have smoked for 10 years or more)

Have one or more of the symptoms listed below (where these symptoms cannot be explained by obvious causes such as current lower respiratory tract infection, known heart failure or known cancer):

Coughing up blood, persistent cough, chest/shoulder pain, dyspnoea (difficult or laboured breathing), unexplained weight loss, chest signs, finger clubbing (changes in the shape of the fingers or finger nails), hoarseness, persistent or recurrent chest infections and cervical/supraclavicular lymphadenopathy (enlargement of lymph nodes in the neck).

Commenting on the study, Jamie Thorne from Gravells Pharmacy, Llangennech said “we could not wait to get involved with the Hywel Dda Chest X-Ray referral pathway. It is very important that patients get fast tracked to earlier diagnosis of chronic conditions like COPD, Asthma, Bronchitis and even Lung Cancer. Rather than referring them to a GP and then waiting weeks for another referral we can directly send them to hospital within 48 hours, saving valuable time to the patient and vastly improving patient care. As community pharmacists we are interacting with hundreds of patients every day and as we are open 5 and a half days a week, patients can pop in anytime to consult a pharmacist and discuss their symptoms.”

If you would like to know more look out for the posters at eligible pharmacies, visit the Hywel Dda website: http://www.wales.nhs.uk/sitesplus/862/page/98900, or contact the study team at Prince Philip Hospital on 01554 779307.